Unlike hip or knee osteoarthritis, the ankle is not frequently affected by degenerative changes. When they occur, it usually is the consequence of fractures or sprains, thus affecting a much younger and active population.
The first approach is usually conservative, with activity modification, shoeware adaptation, medication, physiotherapy and/or joint infiltrations.
In some cases, the deviation in the joint line is the cause for cartilage wear, thus realignment surgery may interrupt the degenerative process. These procedures are what is nowadays referred to joint preserving surgery.
The case bellow represents a rare condition, in which the lateral tibial intra-articular defect, lead to a valgus ankle osteoarthritis.
In the surgical planning we can verify the need to perform an intra-articular correction, exactly were the centre of rotation of angulation (CORA) is located, to proceed with the restoration of the normal articular anatomy.
Besides the intra-articular tibial lateral addition osteotomy, a fibular lengthening and medializing calcaneal osteotomy was performed.
In more advanced osteoarthritis cases or older age, the success of joint preserving surgery become less, hence arthroplasties being a solution that maintains articular motion.
Although technically challenging, these procedures currently present good survival rates and preservation of a more effective gait pattern.
The classical procedure for the treatment of terminal osteoarthritis is arthrodesis, meaning osseous fusion between the tibia and the talus.
It is a procedure with good functional outcome, when fused in a good position. There are many approached that can be performed to complete the procedure: anterior, lateral, posterior or arthroscopic, depending on the changes and co-morbilities present.
In the present case, an arthroscopic arthrodesis was performed, due to the limited arterial perfusion of the limb.
Apart from ankle arthritis, also the joint bellow –subtalar joint – can also be subject of degeneration.
In the presented case, there is a long term wear of the subtalar joint has led to hindfoot valgus deformity, causing erosion of the lateral maleollous by the calcaneal bone.
The peroneal tendons (image bellow) were dislocated and presented extensive longitudinal ruptures.
A subtalar arthrodesis with interposition of a synthetic wedge was performed, to recover the calcaneal height. Both peroneal tendons were repaired, toghether with the gutter and retinaculum.
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